CDC no longer recommends universal contact tracing, case investigation

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The Centers for Disease Control and Prevention (CDC) announced this week that it no longer recommends universal case investigation and contact tracing.

In its place, the agency said state, tribal, local and territorial (STLT) health departments should prioritize specific settings and groups at increased risk. 

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The updated guidance said those institutions should focus their efforts on promoting proven prevention strategies to reduce transmission of COVID-19 in the community. 

Decisions to initiate contact tracing and case investigation should be made separately, with investigations targeting COVID-19 cases and close contacts with onsets and exposures in the previous 5 days for those settings and groups at increased risk.

Additionally, STLT health departments should consult with schools, businesses and organizations that provide essential services to help them implement appropriate COVID-19 prevention measures, support public health education, offer COVID-19 vaccinations and have the authority to determine how case investigation and contact tracing should be implemented locally.

Students wear face masks and are seated with empty desks separating them from their classmates in a 2nd grade class at School 16 in Yonkers, N.Y., Oct. 20, 2020. (AP Photo/Mary Altaffer, File)

"Case investigation and contact tracing are separate processes that have distinct benefits and outcomes," the CDC said. "Implementation of each activity should be considered separately. Not all cases that are investigated will result in the elicitation and notification of close contacts. It is important to prioritize investigation of COVID-19 cases with symptom onset or positive viral test within the previous 5 days. Notification of close contacts should occur within 5 days of their last known exposure to someone with COVID-19."

"This time-based strategy will have the greatest impact on onward transmission and ensure priority cases and their priority close contacts can be reached in sufficient time follow recommended isolation and quarantine guidance and seek treatment as appropriate," the agency added. 

The health departments should concentrate on the investigation of cases, clusters and outbreaks involving long-term care facilities, correctional facilities and homeless shelters, unusual clusters of cases and novel or emerging variants that could pose significant risks for severe disease, hospitalization and death. 

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Alternatively, the departments should emphasize elicitation and notification of close contact with exposure in the previous five days identified during the investigations, including those recommended for quarantine and those at increased risk of severe health outcomes and death. 

However, the CDC noted that broad-based notification of potential exposure and testing "may be more effective" than contact tracing for responding to outbreaks and controlling virus transmission.

As the recommendations adjust, the agency wrote that health departments may need to adjust staffing levels accordingly.

Furthermore, to complement these activities, STLT health departments should offer vaccination and testing, implement testing strategies, connect those with COVID-19 who are at risk for severe health outcomes to antiviral and other treatments, encourage people who are positive to notify their own close contacts, expand the use of digital tools, promote the use of well-fitting masks and physical distancing in community settings and promote the benefits of being up to date with COVID-19 vaccination. 

These changes come as public health experts remain cautiously optimistic about current pandemic trends, with new cases and hospitalizations continuing to fall. 

Data from the Johns Hopkins Coronavirus Resource Center shows 52,355 new cases and nearly 2,100 new deaths in the past day. 

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New York City's contact tracing program will end its universal tracing efforts toward the end of next month and Indiana state officials announced Thursday that its schools and child care programs will no longer have to conduct contact tracing or report COVID-19 cases to the state Department of Health as of next Wednesday.

The Associated Press contributed to this report.